Heat-Resilient Schoolyards: Relations Between Temperature, Shade, and Physical Activity of Children During Recess.

BACKGROUND: Extreme heat may discourage physical activity of children while shade may provide thermal comfort. The authors determined the associations between ambient temperature, shade, and moderate to vigorous physical activity (MVPA) of children during school recess. METHODS: Children aged 8-10 (n = 213) wore accelerometers and global positioning system monitors during recess at 3 school parks in Austin, Texas (September-November 2019). Weather data originated from 10 sensors per park. The authors calculated shade from imagery using a geographic information system (GIS) and time-matched physical activity, location, temperature, and shade data. The authors specified piecewise multilevel regression to assess relations between average temperature and percentage of recess time in MVPA and shade. RESULTS: Temperature ranged 11 °C to 35 °C. Each 1 °C higher temperature was associated with a 0.7 percentage point lower time spent in MVPA, until 33 °C (91 °F) when the association changed to a 1.5 lower time (P < .01). Each 1 °C higher temperature was associated with a 0.3 percentage point higher time spent under shade, until 33 °C when the association changed to a 3.4 higher time (P < .001). At 33 °C or above, the direct association between shade and MVPA weakened (P < .05), with no interaction effect above 33 °C (P > .05). Children at the park with the most tree canopy spent 6.0 percentage points more time in MVPA (P < .01). CONCLUSIONS: Children engage in less MVPA and seek shade during extreme heat and engage in more MVPA in green schoolyards. With climate change, schools should consider interventions (eg, organizing shaded play, tree planting) to promote heat safe MVPA.

The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design.

BACKGROUND: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. OBJECTIVE: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. METHODS: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening-physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. RESULTS: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening-physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). CONCLUSIONS: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.

Effects of Large-Scale Municipal Safe Routes to School Infrastructure on Student Active Travel and Physical Activity: Design, Methods, and Baseline Data of the Safe Travel Environment Evaluation in Texas Schools (STREETS) Natural Experiment.

Past evaluations of Safe Routes to School (SRTS) programs have been relatively small in scope and have lacked objective measurements of physical activity. A 2016 Mobility Bond in Austin, Texas, USA, allocated USD 27.5 million for infrastructure changes to facilitate active commuting to schools (ACS). The Safe TRavel Environment Evaluation in Texas Schools (STREETS) study aims to determine the health effects of these infrastructure changes. The purpose of this paper is to describe the STREETS study design, methods, and selected baseline results. The STREETS study is comprised of two designs: (1) a serial cross-sectional design to assess changes in ACS prevalence, and (2) a quasi-experimental, prospective cohort to examine changes in physical activity. Differences between study arms (Austin SRTS and comparison) were assessed for school demographics, ACS, and school programs. At baseline, 14.3% of school trips were made by ACS, with non-significant differences between study arms. Only 26% of schools implemented ACS-related programs. Some significant differences across SRTS and comparison schools were identified for several school- and neighborhood-level characteristics. Substantial changes are needed across area schools and neighborhoods to promote optimum ACS. STREETS study longitudinal findings will be critical for informing optimal future implementations of SRTS programs.

Acceptance- and mindfulness-based techniques for physical activity promotion in breast cancer survivors: a qualitative study.

PURPOSE: The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors. METHODS: The acceptance- and mindfulness-based physical activity intervention was delivered to participants electronically over the course of 4-8 weeks. It consisted of didactic videos, experiential exercises, and workbook-type activities that targeted principles from acceptance and commitment therapy (ACT). We conducted semi-structured, in-depth interviews with participants after they completed the intervention. Three coders conducted qualitative data analysis on interview transcripts to identify overarching themes and subthemes. RESULTS: We recruited 30 participants. Of those, 16 engaged in an individual interview. The mean age of the sample was 58.4 years (SD = 13.8). The sample was relatively well educated (50.0% college graduates) and mostly overweight or obese (58.8%). We identified two overarching themes from interviews. They were centered on (1) internal and external barriers to physical activity adherence and (2) the utility of targeting core ACT processes (acceptance and defusion, mindfulness, and values clarification) for physical activity promotion. CONCLUSION: Intervention content was perceived to be acceptable, relevant, and to fulfill important needs related to healthy living. Findings suggest that this approach to physical activity promotion can be delivered effectively online. Electronically delivered acceptance- and mindfulness-based approaches hold promise for helping insufficiently active breast cancer survivors increase physical activity.

School Parks as a Community Health Resource: Use of Joint-Use Parks by Children before and during COVID-19 Pandemic.

Parks are settings for physical activity that can support the physical and mental health of children during the COVID-19 pandemic. We determined the impact of the pandemic on the use of joint-use parks outside of school hours by children in Austin, TX, United States. In autumn of 2019 and autumn of 2020 (i.e., before and during the COVID-19 pandemic), we used an adapted version of the System for Observing Play and Recreation in Communities to observe whether children aged 1-12 participated in physical activity (i.e., sedentary, light and moderate, vigorous) at three parks located at schools serving mostly economically disadvantaged Latinx families. In 2020, we also observed whether children maintained social distance and wore face coverings. Results of negative binomial regression modeling revealed the pandemic was associated with a 46% [95% CI: 20-63%] and 62% [95% CI: 39-76%] decrease in the number of girls and boys at parks, respectively, and a 42% [95% CI: 16-59%] and 60% [95% CI: 36-75%] decrease in the number of girls and boys engaging in physical activity, respectively (p < 0.01). In total, 60.6% of girls and 73.6% of boys were not social distancing, and 91.8% of the time no children wore masks. Interventions should be considered to safely reintroduce children to parks for health benefits during pandemics.

Structural Racism and Immigrant Health: Exploring the Association Between Wage Theft, Mental Health, and Injury among Latino Day Laborers.

Background: Although wage theft has been discussed primarily as a labor and human rights issue, it can be conceptualized as an issue of structural racism with important consequences for immigrant health. Objectives: The objectives of this study were to: 1) identify sociodemographic, employment, and stress-related characteristics that increase Latino day laborers' odds of experiencing wage theft; 2) assess the association between wage theft and serious work-related injury; 3) assess the association between wage theft and three indicators of mental health-depression, social isolation, and alcohol use-as a function of wage theft; and 4) assess serious work-related injury as a function of wage theft controlling for mental health. Methods: Secondary data analyses were based on survey data collected from 331 Latino day laborers between November 2013 and July 2014. Regression analyses were conducted to test the relationships described above. Results: Approximately 25% of participants reported experiencing wage theft and 20% reported serious work-related injury. Wage theft was associated with working in construction and was initially associated with work-related injury. Wage theft was not significantly associated with mental health indicators. The association between wage theft and injury became non-significant when controlling for the mental health variables. Conclusions: The hardship and stress associated with wage theft incidents may ultimately lead to more frequent injury. Although we expected an association of wage theft with mental health, we found vulnerability to physical health as indicated by injury incidents. Thus, our basic premise was partially supported: wage theft may act as a stressor that stems from conditions, in part, reflecting structural racism, making workers vulnerable to poorer health.

Patterns of self-monitoring technology use and weight loss in people with overweight or obesity.

Mobile applications and paired devices allow individuals to self-monitor physical activity, dietary intake, and weight fluctuation concurrently. However, little is known regarding patterns of use of these self-monitoring technologies over time and their implications for weight loss. The objectives of this study were to identify distinct patterns of self-monitoring technology use and to investigate the associations between these patterns and weight change. We analyzed data from a 6-month weight loss intervention for school district employees with overweight or obesity (N = 225). We performed repeated measures latent profile analysis (RMLPA) to identify common patterns of self-monitoring technology use and used multiple linear regression to evaluate the relationship between self-monitoring technology use and weight change. RMLPA revealed four distinct profiles: minimal users (n = 65, 29% of sample), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5%). The dedicated all-around users with exceptional food logging lost the most weight (X2[1,225] = 5.27, p = .0217). Multiple linear regression revealed that, adjusting for covariates, only percentage of days of wireless weight scale use (B = -0.05, t(212) = -3.79, p < .001) was independently associated with weight loss. We identified distinct patterns in mHealth self-monitoring technology use for tracking weight loss behaviors. Self-monitoring of weight was most consistently linked to weight loss, while exceptional food logging characterized the group with the greatest weight loss. Weight loss interventions should promote self-monitoring of weight and consider encouraging food logging to individuals who have demonstrated consistent use of self-monitoring technologies.

Mobile applications and paired devices now enable users to track their physical activity levels, dietary intake, and weight fluctuations all in one user interface. We know that tracking each of these behaviors generally facilitates weight loss, but it is not clear how people with overweight or obesity may tend to use these multiple functions together when trying to lose weight. In a sample of 225 school district employees with overweight or obesity, we investigated whether there were common patterns in tracking these behaviors over time, and whether patterns were associated with weight loss. We identified groups reflecting four common patterns, which we termed the minimal users (n = 65, 29%), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5% of sample). The dedicated all-around users with exceptional food logging was the only group that reliably lost weight and was characterized by high tracking of activity, diet, and weight. Overall, regular use of the weight scale was most strongly associated with weight loss. It may be useful to broadly encourage self-monitoring of weight, and selectively encourage food logging to individuals amenable to this self-monitoring technology.

Heat-Moderating Effects of Bus Stop Shelters and Tree Shade on Public Transport Ridership.

Rising temperatures threaten the resilience of public transit systems. We determined whether bus stop shelters and tree canopy surrounding bus stops moderated the effect of warm season temperatures on ridership in Austin, Texas, and whether shelters and trees were equitably distributed. For bus stops (n = 2271) of Capital Metropolitan Transportation Authority, boardings per bus were measured 1 April-30 September 2019. Air temperature data originated from the Camp Mabry weather station. Tree canopy was calculated by classification of high-resolution aerial imagery from the National Agriculture Imagery Program. Data on race, ethnicity, poverty level, median age, and bus commuters within census tracts of bus stops originated from the 2014-2018 American Community Survey. Using multilevel negative binomial regression models, we found that shelters did not moderate the effect of high temperatures on ridership (p > 0.05). During high temperatures, each one-percent increase in tree canopy was associated with a lesser decrease (1.6%) in ridership compared to if there were no trees (1.7%) (p < 0.001). In general, shelters and trees were equitably distributed. Insignificant or modest effects of shelters and trees on ridership during high temperatures may be attributed to the transit dependency of riders. For climate change adaptation, we recommend tree planting at bus stops to protect from ridership losses and unhealthy exposure to extreme heat.

Cross-Sectional Relationship between Regular Bedtime and Weight Status and Obesity-Related Behaviors among Preschool and Elementary School Children: TX CORD Study.

Background: This study examines the relations between a regular weekday bedtime with weight status, diet quality, physical activity, wellbeing, and parental rules among children 2 to 12 years of age from low-income populations. Methods: The study used baseline data collected in 2012, as part of a larger quasiexperimental study design. A convenience sample of parents of children in preschools, second, or fifth grade attending Head Start centers or elementary schools located in low-income catchment areas, in Houston and Austin, TX, were recruited to participate in the study (n = 32 elementary schools; n = 12 Head Start centers). Regular weekday bedtime was measured with the question "Does your child have a regular weekday bedtime?" Results: The sample of 1467 child-parent dyads were split approximately evenly by sex, and consisted of 44.4% Pre-K, 30.4% second grade, and 25.2% fifth grade students. Six hundred twenty-two (43.6%) children were overweight or obese. Children who had a regular bedtime had 15% lower odds of being overweight or obese (adjusted odds ratio [aOR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p-value: 0.017). Also, children who had a regular bedtime had 45% higher odds of eating the recommended number of fruits and vegetables (aOR: 1.45, 95% CI: 1.02-2.07, p-value: 0.039) and had physical activity more days of the week (ß: 0.42, 95% CI: 0.26-0.57, p-value: <0.001). Conclusions: Having a regular weekday bedtime is associated with better weight status and several obesity-related health behaviors in children. Parental report of regular bedtimes for their children may be an indication of parenting skills related to other health-related behaviors for prevention of childhood obesity.

Adiposity, cardiovascular, and health-related quality of life indicators and the reallocation of waking movement behaviors in preschool children with overweight and obesity: An isotemporal data analysis.

BACKGROUND: Isotemporal substitution evaluates hypothetical time replacement scenarios of physical movement on health, with few studies conducted among ethnically diverse preschool-aged populations. This study examines the reallocation of waking movement behaviors on adiposity, cardiovascular, and quality of life indicators among low-income, majority Hispanic preschool-aged youth (2-5 years) with overweight. METHODS: Participants wore an ActiGraph monitor (waist) and completed adiposity, cardiovascular, and health-related quality of life health assessments. Covariates included age, sex, ethnicity, and socioeconomic status. The isotemporal substitution approach was employed to address study aims. RESULTS: Complete data were available for 131 preschoolers. For boys, reallocating 5 minutes of stationary time with light intensity, moderate to vigorous intensity, or total physical activity showed a relation with beneficial reductions in adiposity indicators; for girls, these relations were statistically null. For boys and girls, reallocating 5 minutes of stationary time [-2.2 (95% CI: -3.7, -0.7) mmHg], light intensity [-2.1 (95% CI: -3.7, -0.7) mmHg], or moderate intensity activity [-2.7 (95% CI: -5.0, -0.4) mmHg] to vigorous intensity activity was related to favorable systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.0, -0.1) mmHg] or total physical activity [-0.2 (95% CI: -0.3, -0.01) mmHg] was related to lowered systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.1, -0.02) bpm] was related to lowered resting heart rate. No significant results for quality of life were found. CONCLUSION: Reallocation of time from stationary time to other movement behaviors is associated with several favorable adiposity and cardiovascular health outcomes among preschool children with overweight and obesity.

Intention to use light-rail transit in Houston, Texas, United States: Findings from the Travel-Related Activity in Neighborhoods study.

Using data from the Houston Travel-Related Activity in Neighborhoods (TRAIN) study, this study examined how various factors affect whether individuals intend to use newly opened light-rail transit (LRT) lines in Houston. The Houston TRAIN study is a natural experiment on the effect of new LRT lines on both transit use and physical activity. A mixed binary logit model was developed based on a dichotomous dependent variable and rich set of variables, including sociodemographic factors, health status, travel behavior and technology, and attitudes and perceptions. The mixed model also allowed accounting for the unobserved heterogeneity across individuals in their sensitivity to observed variables. The results indicated the important role of various factors influencing the decision on intent to use the new LRT lines. In general, demographics mattered but to a lower extent than psychological or personality-related variables. For example, attitudes and perceptions toward the public transit system and consciousness of physical activities derived by using public transit were important factors. Personal health constraints negatively influenced intention to use, while experience with the public transport system was among the positive indicators. The findings show the potential of future interventions in this community to promote use of the new system, such as educational campaigns that improve perceptions of public transit use and clarify the benefits of being active. While providing growing evidence that cognitive variables are important in measuring intention to use public transit, the results emphasize the positive role of efforts integrating transportation and health to develop effective and sustainable solutions.

Factors Associated with Use of Recreational Facilities and Physical Activity Among Low-Income Latino Adults.

The purpose of this study was to identify longitudinal correlates of low-income, urban, Latino adults' use of recreational facilities and engagement in physical activity (PA). This secondary data analysis is from a placed-based initiative; the parent study recruited a cohort of parents of kindergarteners from schools in intervention and control communities. Using a self-administered questionnaire, we collected baseline correlates and 1-year follow-up recreational facilities use and PA outcomes. We conducted ordinal logistic regression to assess correlates for recreational facilities use and PA outcomes. Our sample of 273 Latino adults was mostly female and married or living with partners. Meeting PA guidelines at baseline was associated with higher odds of using parks, walking, and moderate- and vigorous-intensity PA. Those who considered PA to be important had higher odds of using trails (adjusted OR = 2.36, 95% CI 1.15-4.84) and of moderate-intensity PA (adjusted OR = 2.68, 95% CI 1.21-5.91). Reported perception that the neighborhood is very safe to walk was associated with higher odds of using trails (adjusted OR 3.45, 95% CI 1.39-8.53) and parks (adjusted OR 2.92, 95% CI 1.19-7.16). Quality of recreational facilities was directly associated with walking (adjusted OR = 1.61 95% CI 1.01-2.57). Speaking English was associated with higher odds of engaging in moderate-intensity PA (adjusted OR = 3.28 95% CI 1.70-6.33). Results from this study of urban, low-income Latinos indicate that promotion is needed not only for sustained use of recreational facilities among current users, but also for concerted efforts to reach less acculturated Latinos and make recreational facilities appealing to currently inactive adults. Both individual-level and neighborhood-level interventions are needed to build positive attitudes towards PA, while also enhancing neighborhood safety and the quality of neighborhood recreational facilities.

Coaction Between Physical Activity and Fruit and Vegetable Intake in Racially Diverse, Obese Adults.

PURPOSE: There is minimal understanding of the potential for coaction, defined as action on one behavior increasing the likelihood of taking action on another behavior, between physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study was to assess the bidirectional coaction between FV intake and PA, as well as self-efficacy for these behaviors, in a racially diverse sample of obese adults. DESIGN: This is a secondary analysis using data collected from the Path to Health study, a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03674229. SAMPLE: Obese adults who completed baseline and 6-month follow-up assessments. MEASURES: For this study, data on FV intake, leisure time PA, and 7-day accelerometer data were analyzed at baseline and 6-month follow-up. ANALYSIS: We interchanged modeling the FV intake and PA change variables as the independent and dependent variables. We conducted multiple imputation and both linear and multinomial regression. RESULTS: The sample (n = 168) was 59% female and mainly split between white (42%) and African American (42%). Change in self-efficacy for PA was predictive of change in self-efficacy for FV intake and vice versa. When compared with participants with no change in FV intake, someone with a positive change in FV intake was more likely to have a positive change in self-reported PA (adjusted risk ratio [RR] = 6.72, 95% confidence interval [CI] = 1.69-26.68). Likewise, when compared with no change, participants with a positive change in self-reported PA were more likely to report a positive change in FV intake (adjusted RR = 6.79, 95% CI = 1.70-27.17). CONCLUSION: Findings suggest coaction between self-efficacy for FV intake and PA as well as between FV intake and PA. Coaction could be capitalized on to more effectively promote both energy-balance behaviors.

Self-efficacy and Physical Activity in Overweight and Obese Adults Participating in a Worksite Weight Loss Intervention: Multistate Modeling of Wearable Device Data.

BACKGROUND: Physical activity is associated with a reduced risk of numerous types of cancer and plays an important role in maintaining a healthy weight. Wearable physical activity trackers may supplement behavioral intervention and enable researchers to study how determinants like self-efficacy predict physical activity patterns over time. METHODS: We used multistate models to evaluate how self-efficacy predicted physical activity states among overweight and obese individuals participating in a 26-week weight loss program (N = 96). We specified five states to capture physical activity patterns: (i) active (i.e., meeting recommendations for 2 weeks), (ii) insufficiently active, (iii) nonvalid wear, (iv) favorable transition (i.e., improvement in physical activity over 2 weeks), and (v) unfavorable transition. We calculated HRs of transition probabilities by self-efficacy, body mass index, age, and time. RESULTS: The average prevalence of individuals in the active, insufficiently active, and nonvalid wear states was 13%, 44%, and 16%, respectively. Low self-efficacy negatively predicted entering an active state [HR, 0.51; 95% confidence interval (CI), 0.29-0.88]. Obesity negatively predicted making a favorable transition out of an insufficiently active state (HR, 0.61; 95% CI, 0.40-0.91). Older participants were less likely to transition to the nonvalid wear state (HR, 0.53; 95% CI, 0.30-0.93). Device nonwear increased in the second half of the intervention (HR, 1.73; 95% CI, 1.07-2.81). CONCLUSIONS: Self-efficacy is an important predictor for clinically relevant physical activity change in overweight and obese individuals. Multistate modeling is useful for analyzing longitudinal physical activity data. IMPACT: Multistate modeling can be used for statistical inference of covariates and allow for explicit modeling of nonvalid wear.See all articles in this CEBP Focus section, "Modernizing Population Science."

Disparity Indices and Overweight: Frame of Reference.

Purpose: The purpose of this study was to compare state rankings of body mass index (BMI) among three different indices of income disparities (i.e., low-, middle-, and high-income thresholds) and BMI. One measure of disparities was based on national standards and the other measure was based on state-specific data. Methods: Data were from the 2016 Behavioral Risk Factor Surveillance System and analyzed in 2018. To assess differences between the two indices, Spearman Rank Order Correlation coefficient with a Bonferroni adjustment and kappa statistic were used. Results: Spearman rank-order correlation coefficient with a Bonferroni adjustment found that the two indices had a very weak monotonic relationship (ρ=0.11, p=0.46). The kappa value [κ (df=48)=0.02, p-value=0.43] revealed the indices were not concordant. The rankings of states based on national and state-specific disparity indices were distinctly different. Conclusion: Our study highlights the importance of choosing disparity indices. To analyze state similarities and differences, findings and interpretations are different when using a national standard applied to all states versus state-specific data as the frame of reference for the disparity index. Future research is needed to confirm the generalizability of our findings. In addition to income, our approach can be used with other sociodemographic variables such as age, race/ethnicity, sex, and education. The overall goal is to present a comprehensive and nuanced perspective of disparities contributing to the overweight/obesity epidemic.

Cost-Effectiveness of Improvements to the Built Environment Intended to Increase Physical Activity.

Background: Improving sidewalks may encourage physical activity by providing safe, defined, and connected walking spaces. However, it is unknown if reduced health care expenditures assumed by increased physical activity offset the investment for sidewalk improvements. Methods: This cost-effectiveness analysis of sidewalk improvements in Houston, TX, was among adults enrolled in the Houston Travel-Related Activity in Neighborhoods Study, 2013-2017 . The 1-year change in physical activity was measured using self-report (n = 430) and accelerometry (n = 228) and expressed in metabolic equivalent (MET) hours per year (MET·h·y-1). Cost-effectiveness ratios were calculated by comparing annualized sidewalk improvement costs (per person) with 1-year changes in physical activity. Results: The estimated cost-effectiveness ratio were $0.01 and -$0.46 per MET·h·y-1 for self-reported and accelerometer-derived physical activity, respectively. The cost-effectiveness benchmark was $0.18 (95% confidence interval, $0.06-$0.43) per MET·h·y-1 gained based on the volume of physical activity necessary to avoid health care costs. Conclusions: Improving sidewalks was cost-effective based on self-reported physical activity, but not cost-effective based on accelerometry. Study findings suggest that improving sidewalks may not be a sufficient catalyst for changing total physical activity; however, other benefits of making sidewalks more walkable should be considered when deciding to invest in sidewalk improvements.

Foot-based audit of streets adjacent to new light rail stations in Houston, Texas: measurement of health-related characteristics of the built environment for physical activity research.

BACKGROUND: Active travel to and from a transit station may provide significant amounts of physical activity and improve health. The ease with which people can traverse the distance to the transit station may impede or support active travel. Therefore, transit stations that have features that are supportive of utilitarian physical activity would be desirable. This study aimed to characterize the built environment surrounding new light rail transit (LRT) stations in the City of Houston, Texas. METHODS: In 2014, we used a series of systematic protocols and a standardized environmental audit instrument, the Analytic Audit Tool, to collect data on segments (streets) that surround 22 LRT stations that were being newly built. Using Geographic Information System (GIS), we assembled all the segments that intersect a 0.25-mile circular buffer around each station for the audit exercise. Several 3- to 4-member teams of trained auditors completed the audit exercise on a subset of these identified segments. Our analysis were descriptive in nature. We provided the frequency distributions of audited features across the study area. We also followed an original algorithm to produce several composite index scores for our study area. The composite index score is indicative of the prevalence of physical activity friendly/unfriendly features in the study area. RESULTS: In all, we audited a total of 590 segments covering a total of 218 US Census blocks, and eight City of Houston super neighborhoods. Findings suggest the environment around the new LRT stations may not be supportive of physical activity. In general, the audited segments lacked land use integration; had abandoned buildings, had uneven sidewalks; were not bike-friendly, had minimal presence of public-recreational facilities that would support physical activity; and had significant physical disorder. Notably, certain attractive and comfort features were frequently to usually available. CONCLUSIONS: Current findings, which will be compared to follow-up audit data, can be useful for future researchers and practitioners interested in the built environment around LRT stations.

If You Build It, Will They Come? A Quasi-experiment of Sidewalk Improvements and Physical Activity.

Improving sidewalks could lead to more physical activity through improved access, while providing a safe and defined space to walk. Yet, findings on the association between sidewalks and physical activity are inconclusive. PURPOSE: The purpose of this study was to examine changes in self-reported and accelerometer-derived physical activity associated with living near recently improved sidewalks in a diverse, community-based sample from the Houston Travel Related Activity in Neighborhoods (TRAIN) Study. METHODS: Data are from 430 adults and include baseline and first annual follow-up (2014-2017). Fully adjusted, two-step regression models were built to test the hypothesis that living near (within 250-meters) an improved sidewalk was associated with greater levels of physical activity than not living near an improved sidewalk. RESULTS: The majority of participants were female, non-Hispanic black, low income, low education, and nearly half lived near at least one improved sidewalk. After adjustment, among participants reporting some physical activity, living near two sidewalk improvements was associated with 1.6 times more minutes per week of walking and leisure-time physical activity than those not living near a sidewalk improvement (p<0.05). Based on accelerometry, which does not specifically quantify domain-specific physical activity, there were no significant associations. CONCLUSION: Although these mixed findings warrant further research, results suggest that improving sidewalks may have an effect on participants' physical activity. Nonspecific definitions of sidewalk improvements could be contributing to type 1 error. Future work should also examine behavioral interventions alongside changes to the built environment to determine the effects on physical activity.

Urban-Rural Differences in Aerobic Physical Activity, Muscle Strengthening Exercise, and Screen-Time Sedentary Behavior.

PURPOSE: Compared to their urban counterparts, US residents in rural settings face an increased risk of premature mortality and health problems that have been linked to insufficient physical activity (PA) levels. There is limited literature regarding urban-rural differences in adherence to national guidelines for all 3 PA-related behaviors. METHODS: We investigated urban-rural differences in aerobic PA, leisure-time muscle strengthening PA, and leisure screen-time sedentary behavior in a combined data set of the 2011-2014 waves (N = 14,188) of the nationally representative National Cancer Institute's Health Information National Trends Survey. FINDINGS: We found no evidence of a difference between large urban and rural residents' aerobic PA levels. The typical number of weekly bouts of leisure-time muscle strengthening PA was 25% lower for rural residents (incidence rate ratio [IRR] = 0.751, P < .001); this relationship was no longer statistically significant after controlling for potentially confounding covariates. In adjusted models, we found rural residents to engage in 6.6% less daily leisure screen-time sedentary behavior than their large urban counterparts (IRR = 0.934, P = .031). CONCLUSIONS: Taken together with previous literature, these results suggest that rural residents may engage in comparable levels of total PA, but less leisure-time PA, than their urban counterparts.